LRB-2175/1
DAK/MDK/MES:jld:pg
2003 - 2004 LEGISLATURE
August 20, 2003 - Introduced by Senators Cowles, Schultz, Erpenbach, Robson
and Risser, cosponsored by Representatives Underheim, Krawczyk, Ott,
Nass, Seratti, Hahn, Sherman, Grothman, Coggs, Staskunas, J. Lehman,
Gunderson and Albers. Referred to Committee on Health, Children,
Families, Aging and Long Term Care.
SB232,1,11
1An Act to amend 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h), 50.09 (1) (k),
250.49 (1) (b) (intro.), 70.47 (8) (intro.), 146.82 (3) (a), 252.07 (8) (a) 2., 252.07 (9)
3(c), 252.11 (1m), 252.11 (2), 252.11 (4), 252.11 (5), 252.11 (7), 252.11 (10), 252.12
4(2) (a) 3. (intro.), 252.15 (2) (a) 7. ak., 252.15 (5) (a) 11., 252.15 (5) (a) 12. b.,
5252.15 (5) (a) 14., 252.15 (5m) (a), 252.15 (5m) (b), 252.15 (5m) (c), 252.15 (7m)
6(intro.), 252.15 (7m) (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 252.18,
7252.23 (5), 252.24 (5), 343.16 (5) (a), 441.06 (title), 448.56 (1), 448.56 (1m) (b),
8448.67 (2), 450.01 (16) (h), 450.11 (7) (b) and 450.13 (5); and
to create 50.01 (1)
9(bm), 252.01 (1c), 441.06 (7), 450.01 (1m) and 450.11 (8) (e) of the statutes;
10relating to: authorizing medically related actions by advanced practice nurse
11prescribers.
Analysis by the Legislative Reference Bureau
Under current law, the Nursing Board grants certificates to issue prescription
orders to advanced practice nurses (advanced practice nurse prescribers) who meet
education, training, and examination requirements of the Nursing Board.
Numerous provisions under current law authorize physicians or other health
care professionals to act under specified circumstances and to affect individuals by
these authorized actions, including all of the following:
1. Unless medically contraindicated as documented by a nursing home or
community-based residential facility resident's physician in the resident's medical
record, the resident has the right to private and unrestricted communications with
his or her family, physician, attorney, and others; to share a room with his or her
spouse if the spouse is also a resident; to participate in activities of social, religious,
and community groups; and to be free from chemical and physical restraints.
2. Home health services that are provided to an individual by a home health
agency must be those specified under a plan for furnishing the services that is
established and periodically reviewed by a physician.
3. For hearings before the local board of review concerning assessments of
property taxes, an ill or disabled person who presents to the board a letter from a
physician or osteopath confirming the illness or disability may present testimony by
telephone.
4. Under laws relating to confidentiality of patient health care records, a
physician who treats a patient whose physical or mental condition, in the physician's
judgment, affects his or her ability to exercise reasonable and ordinary control over
a motor vehicle may, without the patient's informed consent, report the patient's
name and other information to the Department of Transportation. Physicians are
exempted from civil liability for reporting, or not reporting, this information in good
faith.
5. Under laws relating to communicable diseases:
a. The Department of Health and Family Services (DHFS) may order an
individual who has a confirmed diagnosis of infectious tuberculosis or symptoms
indicative of tuberculosis confined to a facility if several conditions are met, including
notifying a court of the confinement and providing to the court a physician's written
statement affirming the tuberculosis or symptoms.
b. If a court orders confinement of an individual with infectious tuberculosis
or symptoms indicative of tuberculosis, the individual must remain confined until
DHFS or a local health officer, with the concurrence of a treating physician,
determines that treatment is complete or that the individual is no longer a public
health threat.
c. A physician or other health care professional who attends a person infected
with a sexually transmitted disease must report the disease to the local health officer
and to DHFS; the physician may examine, diagnose, and treat a minor infected with
a sexually transmitted disease without obtaining consent of the minor's parents or
guardian.
d. If, following a request by an officer of DHFS or a local health officer, a person
reasonably suspected of being infected with a sexually transmitted disease refuses
or neglects examination by a physician or treatment, the DHFS officer or local health
officer may have the person committed to an institution for examination, treatment,
or observation.
e. If a person with a sexually transmitted disease ceases or refuses treatment
before reaching what is in a physician's opinion the noncommunicable stage, the
physician must notify DHFS and the person may be committed for treatment by
DHFS, a local health officer, or a court.
f. If a physician has reported to DHFS a case of sexually transmitted disease,
information regarding the disease and its treatment is not privileged before a court.
g. The State Laboratory of Hygiene must examine specimens for the diagnosis
of sexually transmitted disease for any physician or local health officer and must
report positive results to the local health officer and DHFS.
h. DHFS must promote public awareness of the risk of contracting human
immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency
syndrome) by developing and distributing information to, among other places, offices
of physicians.
i. If certain individuals, including emergency medical technicians, fire fighters,
state patrol officers, jailers, emergency care givers, and coroners, receive a
significant exposure (sustain a contact that has a potential for transmission of HIV),
the person to whom they are significantly exposed may be compelled to be tested for
the presence of HIV, and the test results may be provided to the affected individual;
one of the conditions that must be met is that a physician determines and certifies
in writing that the individual has been significantly exposed.
j. Positive results of a test for the presence of HIV that is administered to a
corpse may be provided by the individual's attending physician to persons whom the
physician knows have had sexual contact or shared intravenous drug use
paraphernalia with the deceased person, to emergency caregivers, and to funeral
directors, coroners, and medical examiners who prepare a corpse for burial or
perform an autopsy and are significantly exposed, as determined by a physician.
k. If a local health officer or DHFS officer requires it, a person who is employed
in the handling of food products or is suspected of having a disease in a form that is
communicable by food handling must submit to an examination by the officer or by
a physician.
L. Regulations of tattooists and body piercers do not apply to a dentist or
physician who tattoos or pierces the bodies of persons in the course of the dentist's
or physician's professional practice.
6. Under occupational regulation laws relating to physical therapists, a
physical therapist may practice only on the written referral of a physician,
chiropractor, dentist, or podiatrist, except under certain conditions, including
providing services to an individual for a previously diagnosed medical condition after
informing the individual's physician, chiropractor, dentist, or podiatrist.
7. Under occupational regulation laws relating to podiatrists, a podiatrist who
renders chargeable services to, among others, a patient or physician, must render a
statement of the charge directly to the person served.
8. Under laws relating to the practice of pharmacy, current law does the
following:
a. Defines the term "practice of pharmacy" to include making therapeutic
alternate drug selections in accordance with written guidelines or procedures
approved by a hospital or by a physician for his or her patients for hospital stay.
b. Prohibits from use as a privileged communication information that is
communicated to a physician in an effort unlawfully to procure a prescription drug.
c. Requires the enforcement of these laws that apply to physicians to be the
responsibility of the Department of Regulation and Licensing and the Medical
Examining Board.
d. Exempts from certain requirements for information that must be provided
when dispensing a drug product equivalent the use of drug product equivalents in
hospitals in accordance with guidelines approved by, among others, the patient's
physician.
This bill expands current laws that authorize physicians to act under specified
circumstances and to affect individuals by these authorized actions, by similarly
authorizing advanced practice nurse prescribers.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB232, s. 1
1Section
1. 50.01 (1) (bm) of the statutes is created to read:
SB232,4,32
50.01
(1) (bm) "Advanced practice nurse prescriber" means an advanced
3practice nurse who is certified under s. 441.16 (2) to issue prescription orders.
SB232, s. 2
4Section
2. 50.09 (1) (a) (intro.) of the statutes is amended to read:
SB232,4,115
50.09
(1) (a) (intro.) Private and unrestricted communications with the
6resident's family, physician,
advanced practice nurse prescriber, attorney
, and any
7other person, unless medically contraindicated as documented by the resident's
8physician
or by the resident's advanced practice nurse prescriber in the resident's
9medical record, except that communications with public officials or with the
10resident's attorney shall not be restricted in any event. The right to private and
11unrestricted communications shall include, but is not limited to, the right to:
SB232, s. 3
12Section
3. 50.09 (1) (f) 1. of the statutes is amended to read:
SB232,5,4
150.09
(1) (f) 1. Privacy for visits by spouse. If both spouses are residents of the
2same facility, they shall be permitted to share a room unless medically
3contraindicated as documented by the resident's physician
or by the resident's
4advanced practice nurse prescriber in the resident's medical record.
SB232, s. 4
5Section
4. 50.09 (1) (h) of the statutes is amended to read:
SB232,5,96
50.09
(1) (h) Meet with, and participate in activities of social, religious
, and
7community groups at the resident's discretion, unless medically contraindicated as
8documented by the resident's physician
or by the resident's advanced practice nurse
9prescriber in the resident's medical record.
SB232, s. 5
10Section
5. 50.09 (1) (k) of the statutes is amended to read:
SB232,5,2211
50.09
(1) (k) Be free from mental and physical abuse, and be free from chemical
12and physical restraints except as authorized in writing by a physician
or by an
13advanced practice nurse prescriber for a specified and limited period of time and
14documented in the resident's medical record. Physical restraints may be used in an
15emergency when necessary to protect the resident from injury to himself or herself
16or others or to property. However, authorization for continuing use of the physical
17restraints shall be secured from a physician
or from an advanced practice nurse
18prescriber within 12 hours. Any use of physical restraints shall be noted in the
19resident's medical records. "Physical restraints" includes, but is not limited to, any
20article, device
, or garment
which
that interferes with the free movement of the
21resident and
which that the resident is unable to remove easily, and confinement in
22a locked room.
SB232, s. 6
23Section
6. 50.49 (1) (b) (intro.) of the statutes is amended to read:
SB232,6,624
50.49
(1) (b) (intro.) "Home health services" means the following items and
25services that are furnished to an individual, who is under the care of a physician,
of
1an advanced practice nurse prescriber, by a home health agency
, or by others under
2arrangements made by the home health agency, that are under a plan for furnishing
3those items and services to the individual that is established and periodically
4reviewed by a physician
or by an advanced practice nurse prescriber and that are,
5except as provided in subd. 6., provided on a visiting basis in a place of residence used
6as the individual's home:
SB232, s. 7
7Section
7. 70.47 (8) (intro.) of the statutes is amended to read:
SB232,6,138
70.47
(8) Hearing. (intro.) The board shall hear upon oath all persons who
9appear before it in relation to the assessment. The board shall hear upon oath, by
10telephone, all ill or disabled persons who present to the board a letter from a
11physician,
surgeon or osteopath
, or advanced practice nurse prescriber certified
12under s. 441.16 (2) that confirms their illness or disability. The board at such hearing
13shall proceed as follows:
SB232, s. 8
14Section
8. 146.82 (3) (a) of the statutes is amended to read:
SB232,6,2115
146.82
(3) (a) Notwithstanding sub. (1), a physician
or an advanced practice
16nurse prescriber certified under s. 441.16 (2) who treats a patient whose physical or
17mental condition in the physician's
or advanced practice nurse prescriber's judgment
18affects the patient's ability to exercise reasonable and ordinary control over a motor
19vehicle may report the patient's name and other information relevant to the
20condition to the department of transportation without the informed consent of the
21patient.
SB232, s. 9
22Section
9. 252.01 (1c) of the statutes is created to read: